What are the responsibilities and job description for the Medical Fraud Prevention Expert position at Amerihealth Caritas?
About Us
AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We are committed to upholding the highest ethical standards and working collaboratively with our stakeholders to build healthier communities.
The Clinical Integrity Officer Role
Our Clinical Integrity Officer plays a critical role in leading complex investigations into potential healthcare fraud and abuse, ensuring accuracy, efficiency, and compliance with legal and regulatory standards.
Responsibilities
• Lead investigations into potential healthcare fraud and abuse
• Conduct thorough analyses to detect fraudulent activity and ensure compliance with regulatory standards
• Collaborate with law enforcement agencies, regulatory bodies, and internal teams to uphold organizational integrity
Requirements
• Associate's degree required (Bachelor's preferred)
• Minimum 3-5 years of experience conducting healthcare fraud investigations and collaborating with state, federal, and local law enforcement agencies
• Strong knowledge of Medicaid, Medicare, and fraud-related regulatory statutes required
• Proficiency in Microsoft Excel for data analysis and investigative documentation
Benefits
We offer a comprehensive benefits package, including flexible work arrangements, competitive pay, paid time off, health insurance coverage, and tuition reimbursement.
